Provider Demographics
NPI:1699588988
Name:JENKINS-PRIDGEON, LATRISHA
Entity type:Individual
Prefix:
First Name:LATRISHA
Middle Name:
Last Name:JENKINS-PRIDGEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 WATERTOWER PLACE STE 100
Mailing Address - Street 2:#196
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823
Mailing Address - Country:US
Mailing Address - Phone:616-288-4003
Mailing Address - Fax:
Practice Address - Street 1:1690 WATERTOWER PLACE STE 100
Practice Address - Street 2:#196
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:616-288-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula